Provider Demographics
NPI:1790228153
Name:SOUTHERN FLORIDA PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:SOUTHERN FLORIDA PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANNAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-815-2649
Mailing Address - Street 1:PO BOX 162473
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2473
Mailing Address - Country:US
Mailing Address - Phone:561-815-2649
Mailing Address - Fax:
Practice Address - Street 1:710 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2692
Practice Address - Country:US
Practice Address - Phone:561-815-2649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty